【摘要】 目的 监测我国主要城市三级甲等医院感染患者分离革兰氏阴性菌耐药状况，掌握耐药流行趋势，为抗生素合理使用提供科学数据。方法 定点收集全国18家医院临床分离细菌，由中心实验室统一用琼脂/肉汤二倍稀释法测定抗菌药物最低抑菌浓度(MIC)值。结果 对2023年7月至2024年6月间来自全国18座城市18家医院的4 681株临床分离致病菌进行了MIC测定。结果 显示，大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶(ESBLs)表型检出率分别为50.7%和20.7%,表型检出率继续下降，碳青霉烯类耐药肺炎克雷伯菌(CRKP)比例则较前次监测上升10个百分点，达35.4%。对肠杆菌目细菌抗菌作用较好的药物包括：碳青霉烯类、β-内酰胺合剂、阿米卡星等，细菌敏感率在78%以上。此外，替加环素、依拉环素和黏菌素对各自有效菌属/种保持很好抗菌活性，细菌敏感/中介(黏菌素)率>90%。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为32.7%和70.7%,多重耐药菌(MDR)检出率分别为43.3%和78.3%,泛耐药菌(XDR)检出率分别为17.0%和71.0%。不同病房、不同年龄以及不同标本来源菌株耐药率比较提示，来源重症监护病房(ICU)肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌耐药率均显著高于来源非ICU菌株。儿童分离铜绿假单胞菌对测试药物耐药率均显著低于成人与老年人，但儿童分离肺炎克雷伯菌中ESBLs表型检出率为57.1%,显著高于成人(16.3%)和老年人(19.8%),此外流感嗜血杆菌，来自儿童的菌株对头孢菌素类、阿奇霉素和四环素类耐药率均高于成人和老年人。不同标本来源比较显示，尿标本分离鲍曼不动杆菌对测试药物耐药率显著低于其他来源；其他主要菌种不同标本间在统计学上差异均无统计学意义，痰标本中的铜绿假单胞菌及来源引流液的大肠埃希菌耐药率较其他来源略高。结论 大肠埃希菌、肺炎克雷伯菌中ESBLs表型检出率持续下降，CRKP、氨苄西林耐药流感嗜血杆菌检出率呈上升趋势，需持续关注。更多还原

【Abstract】 Objective To investigate the gram-negative bacteria resistance in nationwide tietiary hospitals,understand the trend of antimicrobial resistance and provide scientific data for the rational use of antibiotis.Method All the clinical isolates were collected from18 hospitals and the minimal inhibitory concentrations(MICs) were tested using agar/broth dilution method recommended by Clinical and Laboratory Standards Institute(CLSI) in central laboratory.Results A total of 4 681 pathogenic isolates from 18 tertiary hospitals in 18 cities nationwide over the period from July 2023 to June 2024 were studied.Based on the MIC results,Escherichia coli and Klebsiella pneumoniae showed extended spectrum β-lactamase(ESBLs) phenotype rates of 50.7% and 20.7%,respectively,ESBLs phenotype rate keeps going down.The ratio of carbapenems resistance Klebsiella pneumoniae(CRKP) was 35.4%,increased by 10 percentage points compared with the previous monitoring.Carbapenems,β-lactam combination agents and amikacin displayed desirable antibacterial activity against Enterobacterales,susceptibal rates were above 78%.In addition,tigacycline,eravacycline,colistin maintained good antibacterial activity against their respective effective bacteria/species,and the bacterial sensitivity rates by more than 90%.Resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipennnem were 32.7% and 70.7% and multidrug-resistant(MDR) detection rates were 43.3% and 78.3%,Extensively drug-resistant(MDR) were17.0% and 71.0%,respectively.Comparison of drug resistance rates from different wards,ages and specimen sources indicated that the proportion of resistance in Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii isolated from intensive care unit(ICU) were significantly higher than non-ICU.Resistance rates of Pseudomonas aeruginosa isolated from children were significantly lower than that in adults and the elderly.However,the detection rate of ESBLs phenotypes in Klebsiella pneumoniae in children was 57.1%,significantly higher than that in adults(16.3%) and the elderly(19.8%).In addition,the strains of Haemophilus influenzae from children had a higher resistance rates to cephalosporins,macrolides,and clindamycin than those in adults and the elderly.Comparisons of different specimen sources showed that the resistance rates of Acinetobacter baumannii isolated from urine specimens were significantly lower than that from other sources.No statistical differences were observed among other major bacterial species in different specimens,while the resistance rates of Pseudomonas aeruginosa in sputum specimens and Escherichia coli in source drainage fluids were slightly higher than those from other sources.Conclusion The detection rates of ESBLs phenotypes in Escherichia coli and Klebsiella pneumoniae have continued to decline,while the detection rates of CRKP and ampicillin-resistant Haemophilus influenzae have shown an upward trend,which requires continuous attention.更多还原